A new reusable instrument designed for simple and secure knot tying in laparoscopic surgery

Experimental results and early clinical experience with an easy method for intracorporeal knot tying using a novel laparoscopic needleholder

BACKGROUND

Intracorporeal suturing and knot tying are among the most difficult procedures in laparoscopic operations. An easy and inexpensive method for intracorporeal instrumental ligation with a modified laparoscopic needle driver is presented.

METHODS

The needle driver developed in this study has a novel mechanism that can fix the suturing thread in a hook at the distal site of the holder's jaw hinge. This hook projects out from the rod only when the jaw of the holder is open. After the needle is removed from the tissue using the grasper, the needle driver is placed under the grasper, which the surgeon manipulates by the left hand. Then the thread is hooked on the needle driver by withdrawal of the driver with the jaw opening. The tip of the needle driver is moved over the shaft of the grasper by keeping the thread on the hook. The thread is entwined during a series of crossing movements of the rods of the forceps. The short tail of the suture material is gripped and tied up as a first throw of ligation. The side edge of the jaw, used for thread cutting, is sharpened by grinding.

RESULTS

When the angle of the forceps is set at 90 degrees in the box trainer, no difference in terms of ligation time and degree of error is observed between the hook and conventional C-loop methods. In the case of the 30 degree forceps angle, the novel method is superior to the conventional method.

CONCLUSION

The novel needle driver provides an easy and inexpensive method for performing an intracorporeal ligation, particularly in a case involving a sharp axis angle of the forceps. More clinical experience is necessary for evaluation of this method, but it has potential advantages in laparoscopic operations.

Videoendoscopic thoracic aorta-to-femoral artery bypass. A feasibility study in a canine model

PURPOSE

This study was undertaken to determine whether videoendoscopic thoracic aorta-to-femoral artery bypass is a technically feasible operation.

METHODS

An acute canine study involving five mongrel dogs was carried out. After the dogs had been given a general anesthetic, the femoral arteries were exposed in the traditional fashion. On the left side, a retroperitoneal, retrorenal tunnel was extended from the common femoral artery to the diaphragm. Under videoendoscopic control, the tunnel was opened through the posterior thoracic attachments of the diaphragm into the thoracic cavity. A Dacron graft was tunneled from the thoracic cavity on the left to the left groin. The thoracic aorta was controlled with a side-biting clamp, and an endoscopically performed end graft-to-side thoracic aortic anastomosis was created. After completion of the thoracic anastomosis, the left femoral anastomosis was created in a traditional manner. A left-to-right femoral bypass completed the lower extremity vascular procedure. An open thoracotomy was avoided.

RESULTS

Videoendoscopic thoracic aorta-to-femoral artery bypass was successfully performed in all five animals. All components of the thoracic procedure, including exposure, dissection, vessel control, cross-clamping, and anastomosis, were performed through the thoracic ports with conventional laparoscopic instruments. Blood loss was minimal. All animals survived the procedure before being killed.

CONCLUSION

Videoendoscopic thoracic aorta-to-femoral artery bypass is a technically feasible operation in a canine model. Advantages of this unique approach over the experimental laparoscopic and the traditional transperitoneal open aortofemoral bypass include ease of aortic exposure, ability to control a segment of disease-free aorta, and anastomosis in a disease-free segment of aorta. Potential advantages include decreased perioperative morbidity rates with the videoendoscopic approach. Before there is clinical consideration of this surgical approach, long-term experiments are required to demonstrate the safety of the procedure.